=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598952095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES LINDBERGH LOWE JR. MSW CSW LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2007
-----------------------------------------------------
Last Update Date | 09/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 MEDPARK DRIVE
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27804-2288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-937-5449
-----------------------------------------------------
Fax | 252-937-5494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 MEDPARK DRIVE
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27804-2288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-937-5449
-----------------------------------------------------
Fax | 252-937-5494
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C005020LCSW
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------